ANGIOGRAPHY VS DOPPLER SONOGRAPHY TO PREVENT VARICEAL HEMORRHAGE

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。试图确定单独的血管造影术(血管的X射线研究)，还是超声和内窥镜指示的血管造影术，对于那些在分流管进入肝静脉将血液输送到肝脏后出血的患者更有效。肝硬变可导致超过60%的患者体液滞留。这种对治疗无效的液体滞留可能与不适、呼吸困难、营养不良、肝肾衰竭以及肝移植后死亡和死亡风险增加有关。一种相对较新的手术称为经颈静脉肝内门体分流术(TIPS)，它在静脉之间建立一条通道，将血液输送到静脉和肝脏。通过在通道中放置一个金属管状结构，该通道一直保持打开。这会改变正在流血的静脉的血液流动路径。由于周围肝脏的组织向内生长，TIPS通道可能关闭。发生这种情况的可能性从六个月的50%-60%到一年的75%-80%不等。如果发生这种情况，胃和食道静脉曲张有内出血的风险，以及腹部液体重新积聚的风险。一种检查和修复分流装置的方法是非常必要的。60名患者将被纳入综合临床研究中心。他们将接受TIPS程序，并将在初步评估期间进行实验室测试。患者将被随机分成两组。TIPS必须在放置后7-10天内正常运行。其中一组将每隔两年每六个月重复进行一次血管造影术(注入染料后对血管进行X光检查)，期间将把针插入颈部静脉，并将细管插入肝脏，以测量将血液输送到肝脏的静脉的压力，并检查分流管是否狭窄。狭窄可以通过用气球拉伸尖端和放置新的支架来纠正。如果临床上有出血的迹象，也会进行血管造影。第二组将重复使用超声波和内窥镜(一种插入中空器官进行观察的仪器)来观察食道、胃和小肠上部。如果发现问题，将进行血管造影术以确认检查结果。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. An attempt to determine if angiography (X-ray study of vessels) alone, or ultrasound and endoscopy-dictated angiography is more effective in patients who hemorrhage after a shunt has been placed into the hepatic veins to bring blood to the liver. Cirrhosis of the liver can cause the retention of fluids in over 60% of its patients. This fluid retention which does not respond to treatment can be associated with discomfort, difficulty breathing, malnutrition, liver and kidney failure, and death and increased risk of death following liver transplant. A relatively new procedure called transjugular intrahepatic portasystemic shunt (TIPS) creates a channel between veins which brings blood into the veins and out of the liver. The channel has been kept open by putting a metal tube-like structure into it. This changes the path of blood flow from the veins that are bleeding. The TIPS channel may close down due to the ingrowth of tissue into it from the surrounding liver. The chances of this occurring range from 50-60% by six months to 75-80% by one year. If this occurs, there is the risk of internal bleeding from varicose veins in the stomach and esophagus as well as a reaccumulation of fluid in the abdomen. A way to check the shunt and to repair it is very necessary. 60 patients will be admitted to the General Clinical Research Center. They will have had the TIPS procedure and lab tests will be done during the initial assessment. Patients will be randomized into two groups. TIPS must be functioning well for 7-10 days after placement. One group will have repeated angiography (x-ray of vessels after a dye has been injected into them) at six month intervals for two years during which a needle will be inserted into a neck vein and a fine tube will be threaded into the liver to measure pressure in the veins bringing blood into the liver and to check for narrowing of the shunt. The narrowing can be corrected by stretching the TIPS with a balloon and a new stent placement. Angiography will also be performed if there are clinical signs of bleeding. The second group will have repeated ultrasounds and endoscopy (an instrument insertion into a hollow organ for viewing) to view the esophagus, stomach, and upper small intestine. If problems are indicated, angiography will be performed to confirm the findings.